Tag Archives: health care

He wrote his first world-renowned book at the age of 26. On weekends he recites love poems (ghazals) on Voice of America. He casually – and humbly – references his more than 70 patents that range from aging wine to chewing gum to bioreactors to air scrubbing systems at his infamous Chicago wine parties. And his mustache rules his twitter feed. In 2013 he was awarded the Star of Distinction, the highest civil award by the Government of Pakistan, for his inventions that are making significant impact in developing countries. He has written over 50 books, well over 100 research papers, and hundreds more articles in the field of science, philosophy, rhetoric, poetry and religion, drawing thousands of hits per day on his blog. Dr. Sarfaraz Niazi might just be the most interesting man in the world, but he is certainly the most interesting man pursuing biosimilars in the United States.

Throughout his career his driving principle has been to make things simpler. He did this while at Abbott Labs, as a former tenured professor at the University of Illinois at Chicago (UIC), in developing countries, and presently in his independent career at Therapeutic Proteins International, LLC (TPI) where he is working on biosimilars – or “copies” of current biologic pharmaceuticals that are about to lose their patents. Although only 17 biosimilars have been approved to date worldwide, though none in US, Dr. Niazi and TPI have nine in the pipeline to transform the entire market. According to photographer Steve Huff, Dr. Niazi is, “An amazing man, in fact the most interesting man in the world!”

Flexibility Is Key To Innovation

When asked his advice to other inventors in a recent interview, Dr. Niazi explained his philosophy that, “You should never get enamored by your thoughts. If the idea does not solve a problem or move the quality of life farther, there are many more things to be invented.” With that mentality, he is filing two products this year alone, similar to Amgen Inc.’s $6 billion molecule white blood count product, due to its expiring patent in the cancer market. Next year, the two molecules he plans to take to market are similar to AbbVie’s expiring $12 billion product Humira.

Dr. Niazi’s strategy is to create an analytical and clinical equivalent to biologics with expiring patents, which is preferred even over a Phase 3 clinical trial. By doing this, the cost of production is reduced drastically and the speed of development increases by 2-3 times. Dr. Niazi estimates an overall reduction in production costs for his biosimilars of up to 50% or higher compared to market competitors.

Although a friend of the FDA, Dr. Niazi is not hesitant to note the tough decisions US-based companies face to stay in the states. Having FDA approval carries weight around the world, but the financial and regulatory burden can be great for inventors and business owners. In contrast, he asserts that the EU has moved ahead of the rest of the world, with the most established and advanced regulatory framework for the authorization and marketing of biosimilars, which has since been adopted by the World Health Organization (WHO).

Through a focus on creating “generic equivalents,” Dr. Niazi is proving that TPI can be wildly successful in the Midwest, and further, that in the same way generics revolutionized how people access pharmaceuticals, biosimilars can revolutionize the way those around the world access lifesaving treatments.

As his biosimilars enter the market with FDA approval, the ability of Dr. Niazi to impact the entire health sector grows because his biosimilars can be substituted for its reference product without provider or patient intervention. However, the FDA has not yet finalized these guidelines, and only 17 biosimilars have been approved internationally to date, of which none are by the FDA.

Ultimately, with numerous billion-dollar biologics coming off patent over the next six years, and the exorbitant cost for specialty drugs, the nine biosimilars TPI has in the pipeline stand to make a huge impact in the health sector. While Dr. Niazi could be doing many interesting things these days as an international man of mystery, he has devoted his research, time and energy to bringing high quality, cost-effective treatments to the US, and beyond. So long as he maintains his wine parties and poetry readings, its certain no one will complain.

Building any brand can be difficult, but in the US, hospital identity and branding are paramount to success within a community. By listening to patients, getting feedback on wants and needs, engaging individuals and creating new incentives, a better reputation, greater trust and improved health outcomes can all be achieved.

Below are 10 things hospital leadership should keep in mind when thinking about marketing and strategy in 2014 and beyond.

In 2013, it was estimated that 62% of emails were opened on a mobile device. Checking email is the top mobile activity among smartphone and tablet users. More people in the world own a mobile device than a toothbrush, so using email to inform patients about new services, community events and preventative care tactics is a must.

Surprisingly, Grandparents are the fastest growing demographic on Twitter. Not only does this indicate that it is here to stay as a social media platform, but it’s a great place to target our aging population who consume the majority of our health services.

In 2014, more than 50% of Internet users, or 102.5 million people in the US, will redeem a digital coupon. There are many new partnerships with retail clinics, pharma companies and other service providers that can use coupon-like strategies for patient cost-savings and adherence.

The number of devices connected to the Internet now exceeds the number of humans on earth. So don’t forget to market on multiple platforms and for many different devices. Top sites include Twitter, Facebook, Pinterest and Instagram.

Social media influences 93% of shoppers final purchase decisions. Further, 90% of consumers indicate that they trust peer recommendations. Therefore, previous patients are your greatest allies. Their reviews online matter more than you think.

More than 78% of US Internet users research products and services online, and every month, there are more than 10.3 billion Google searches, with most people clicking one of the top four links. What your top hits say about your organization, your providers and your quality of care can influence your bottom line.

Targeted, content marketing costs 62% less than traditional marketing, and, per dollar spent generates about 3 times as many leads. When creating a marketing strategy for a particular service line, service, or physician group, think about exactly who needs to see what ad and what information they will be looking for.

Consumers that receive email newsletters from companies spend 82% more with those companies. Think about what that says for brand loyalty following engagement, and about the ability of constant, relevant engagement. Patients are consumers, and like email, newsletters keep them informed.

70% of people surveyed claim they would rather learn about a hospital or company through articles rather than direct advertisements. Therefore, not only are advertising campaigns important, but so are the patient experience testimonies, community reviews and Forbes articles that highlight the work being done inside and outside of your hospital.

With the release of their new HeartAssist5 heart pump, ReliantHeart is making real-time, personalized feedback possible for the millions of Americans suffering from heart failure. The new technology allows for real-time, remote monitoring of implantable devices, years of added life for patients, and flexibility to travel without a physician nearby. With a staggering projected 46% growth in heart failure by 2030, advances in heart failure innovation are on the forefront of changing medical treatment, policy, device research and physician reimbursements. Further, with heart failure and disease disproportionately affecting minorities in the US, advances in length and quality of life could be huge strides for medical equality.

Heart Failure In America

Approximately 7.5 million people in the United States currently suffer from heart failure, a figure that is increasing over time as more people survive heart attacks and various other heart conditions. According to the Heart Failure Society of America, an estimated 400,000 to 700,000 new cases of heart failure are diagnosed each year, with deaths averaging 250,000 annually, more than double since 1979. Even worse, an estimated one half of heart failure patients die within five years of diagnosis and 20% within the first year.

With a waiting list for heart transplants at an overwhelming 3,736 at publication, and less than 2,500 hearts donated annually, the need for a bridge between heart failure and transplant is literally life and death.

LVADs

Left ventricular assist devices (LVAD) are implantable heart pumps that were created to temporarily support patients with advanced heart failure as the bridge between diagnoses and transplant. However, with new scientific advancements, LVADs are becoming a long-term tool for improving heart function without transplant.

The right ventricle pumps blood to the lungs, but the left ventricle is responsible for pumping blood to the rest of the entire body, making it much more susceptible to failure. Therefore, LVADs have been the focus of most modern research to prolong and improve life saving implants.

Patient-Centered Care

Reliant’s system acts like your car’s dashboard. “If a patient’s pump has any sign of a challenge, like dehydration or low flow, the remote monitoring system signals the change to a data-collection center that notifies the transplant center as well as the individual,” ReliantHeart CEO Rodger Ford says. This is what makes the HeartAssist5 unique; at the first sign of a problem the right people are notified immediately.

Essentially, if the engine light goes on, the heart center and patient are notified to get the engine checked.

He also notes that the patients can set monitors to send text message notifications, thus making changes in blood flow, speed and power truly personalized. Individual blood flow is collected and transmitted every 5 minutes, making one’s own body the standard comparator.

The greatest importance to Founder and CTO Bryan Lynch is his ability to use his background as an engineer to, “Get involved in a project where you can actually see how you saved a life. While the docs and nurses are the real lifesavers, we give them the tool to make it possible.” He continues that it is vitally important for engineers and innovators to gain a patient-centered approach to get a real reduction in cost burden and improve quality of life.

Sailesh Saxena, CFO, continues highlighting the patient focus of the company by telling about the origination of the design of the VAD pack. “Bryan and I used to go to Schlotsky’s Deli ($BUNZ) for lunch,” he said, “and we used to see this man wearing a coat although it wasn’t cold out. Bryan noticed immediately that he was attempting to hide an LVAD controller and batteries. Well, this happened more than once, and we recognized that he was always concealing the VAD controller. So we decided that we needed to create a unique insert so that our LVAD control system could slip right into a Louis Vuitton ($LVMH) or Gucci ($GUC) bag unnoticed. It’s the small things that make the patient feel like we understand what they really want.”

Expanding The Geography Of Care

Remote monitoring, like other methods of telemedicine, is a key to expanding the geography of health care. “As technology matures, with the help of remote monitoring, the cardiologist and patient will feel safer with greater distances between them,” says Saxena.

This growth in telemedicine as a whole, and specifically in heart care, has major implications for the Centers for Medicare & Medicaid Services (CMS) as well as health care policy and reform. Because CMS is beginning to assign reimbursements and penalties based on patient outcomes instead of traditional fee-for-service metrics, it will become more and more important to have reimbursements reflect remote monitoring and its likely benefits.

Reimbursement codes also need to be reworked to genuinely target geographic discrepancies in care, which are fundamentally important for transplant centers. However, at present, CMS is slowly beginning to take growth rates of heart implants seriously based on the agency’s continued increases in payments, including their slight variations in geographic differences.

An Engineering Feat

In a recent study, researchers found that platelets flowing through the HeartAssist5 are exposed to significantly lower cumulative shear stress levels than in competitive devices tested. Ultimately, this means that the ReliantHeart product allows for what the CTO calls “a more physiologically normal cardiac output, including the pulse.”

What Bryan means is that people with failing hearts have low blood flow throughout the body, which is why they are so sick. When an LVAD is implanted, patients return to a more normal flow, but they also need blood flow that is as natural as possible. With the HeartAssist5, blood is not damaged and any pulse that the recovering heart produces is naturally transmitted to the body.

The LVAD and heart now work together to help the patient recover.

Although there are two other continuous flow LVADs on the market (THOR and HTRW), the ReliantHeart team claims their careful design capitalizes on working with the natural ventricle to the benefit of the patient, almost like a gym trainer for your heart.

Their “implantable flow probe” is also a revolutionary aspect of the HeartAssist5. This ultrasonic probe measures the blood flow from the LVAD in real-time providing critical feedback that is a one-of-a-kind technology providing data that makes the aforementioned remote monitoring so valuable. Ford says this ability to see patient-specific trends remotely in real time not only helps all patients improve quality of life, but the longevity of the HeartAssist5 creates a life support system, far beyond the “bridge” that the LVAD was originally created to be.

So this month, for American Heart Month, think about what innovation really is. It might be the ability to prolong and add quality of life for individuals and families across the nation, to share more time with loved ones.

In the months leading up to World Mental Health Day, DC has been shaken by a series of violent events that ended with innocent lives lost and our country’s mental health services called into question. During this same time period, Washington, DC has been consumed by a government shutdown, with lawmakers and policymakers trying to determine how to rein in our country’s financial burdens and overspending. Unfortunately, as federal and state governments look to cut budgets at every turn, mental and behavioral health services are often on the chopping block first. Financial cuts, compounded with US stigma often applied to mental health troubles and disparate access to services across the county, mean that those who need services most are often those left without proper care.

August though October brought DC into the spotlight for many reasons, the saddest of which is the violence that was covered by mass media as two shootings occurred. In one case, Aaron Alexis, a 34-year-old, perpetrated a mass shooting that left 12 people dead, in Washington’s Navy Yard. Previous to the shooting, it was reported that Mr. Alexis was treated at the VA for mental health issues including sleep disorders and paranoia, but had not lost clearance.

Miriam Carey, also 34, reportedly had an unhealthy obsession with the White House when she drove her car into the White House gates and led police on a chase around DC before being killed. Although she had no reported psychosis or supposed violent intent, it was noted in the months leading up to the incident she believed that the President had beenstalking her and might have suffered from postpartum depression. When killed by authorities on Pennsylvania Avenue, she had her 18-month-old child in the car.

Budget Cuts

Although societal stigma and knowledge of where to access behavioral and mental services are often barriers to care, budget cuts continue to make seeking care more difficult. Whether this be through decreases in available services, lack of providers due to poor reimbursements or less preventative actions in communities, the impact of mental health funding shortages is great. According to the National Alliance on Mental Illness, “increasingly, emergency rooms, homeless shelters and jails are struggling with the effects of people falling through the cracks due to lack of needed mental health services and supports.”

In the last five years, significant budget cuts have befallen mental health programs and services. From 2009 to 2011, states cut mental health budgets by a combined $4 billion- the largest single combined reduction to mental health spending since de-institutionalization in the 1970s. In Chicago alone, state budget cuts combined with reductions in county and city mental health services led to shutting six of the city’s 12 mental health clinics. These closures, along with other public and private center closures in Chicago, have eliminated vitally needed services, especially on the south and west sides where they are indispensable.

Threats of sequestration in 2013 had a significant impact on people’s ability to access mental health services and programs, including children’s mental health services, suicide prevention programs, homeless outreach programs, substance abuse treatment programs, housing and employment assistance, health research, and virtually every type of public mental health support. The Substance Abuse and Mental Health Services Administration(SAMHSA) claimed it alone would be cutting $168 million from its 2013 spending, including areduction of $83.1 million in grants for substance abuse treatment programs.

Consequences

Despite the need to balance budget and make all health care services more efficient, many argue that society has better long-term outcomes if more federal and state dollars are allocated to mental and behavioral health care. This includes preventative services as well as mental health testing and treatment.

Because individuals with untreated mental illness often find themselves in emergency rooms, homeless shelters and prisons, the societal cost of prevention and treatment may be exponentially less than funding those other outlets and catchment areas. This is especially true in the case of children, who face cycling in and out of the system throughout their lives if left untreated.

These costs can be exceptionally large over the lifetime given that the National Institute of Mental Health (NIMH) estimates that two-thirds of children with lifetime mental health problems never receive treatment. This takes substantial emotional and financial tolls on individuals and families, as well as the broader society. However, programs that address the mental health needs and provide services for youth show better outcomes in health and education that carry over the lifetime. For example, in the University of Chicago’s Crime Lab, therapy is being used to curb youth violence, especially amongst those with behavioral and mental health care needs.

Additionally staining on the mental health care system is that during times of recession and budget cuts the caseload for mental health actually increases. It has been estimated that during this most recent recession, the caseload of community mental health services alone has increased almost 50 percent. This increase has most notably been seen in the Native American community, where suicide prevention is an essential part of the cultural health care demands.

Everyone Benefits

The NIMH contends that one in 17 people suffer from a “seriously debilitating mental illness,” we as a society are accountable for ensuring that those in need have resources for care. Not only does access to quality mental and behavioral health care ensure that individuals are being properly treated, but that America as a whole saves money and resources caring for those in need in other, more expensive settings. It may further prevent violent acts like those in DC from happing.

On this World Mental Health day think about the ways in which access to and support of mental and behavioral health care can be improved in your community.

The days after September 11th, 2001, the city of New York was enveloped in a blanket of ash. Rescue workers spent hours, days, even months without rest sorting through rubble and dust, exposing themselves to all kinds of physical dangers. These images are well documented in newspapers, television images and museums. But the haunting images from the aftermath, including the one of firemen I keep in my kitchen, do not tell the ongoing story of the men and women who risked their lives, physical health and mental health to dig the magnificent city out of the ash.

Despite the immediate coverage of heroism for the country’s rescue workers, very few have taken time in the last 12 years to fully research the physical and mental toll taken on those individuals that risked their lives on September 12thand the following days. According to the City’s Department of Mental and Physical Hygiene “thousands of individuals—including rescue, recovery and cleanup workers and people who lived, worked or went to school in Lower Manhattan on September 11th—have developed chronic, and often co-occurring, mental and physical health conditions.”

Understanding The Impact

Most of what is known about the issues affecting thousands of domestic and international rescuers has been collected by the New York City HealthDepartment’s World Trade Center Health Registry. This Registry, which allows health professionals to track and investigate illnesses and recovery related to September 11th also helps create guidelines that can save lives and reduce injuries in future disasters.Dr. Robert Gillio, who is significantly responsible for its creation claims that, “The Registry was not part of any preplanning. Nor was the care of the New York Police Department (NYPD) or construction volunteers. I got a panicked call from someone that knew I had developed a middle school lab kit enabled laptop with curricula for how to measure heart and lung function and learn how to protect them. It was something I created for my four daughters to make health and science education more interesting.”

Following that creation, Dr. Gillio says, “When I joined up with a team of volunteers screening NYPD officers, this early telemedicine app was used to create health records. We had the presence of mind to realize the vast differences in the levels of exposure and decided to create questionnaires for what is called risk stratification.”

From that point forward the Registry has providedguidelines for domestic and international health care providers to care for those who volunteered in the aftermath of September 11th by creating flow charts, tracking systems and symptom coordination for individuals who may be experiencing conditions related to World Trade Center exposures. The database has collected information on more than 70,000 people over a decade and includes not just the official heroes of September 2001, the NYPD and the Fire Department of New York (FDNY), but also the volunteer and paid professionals that tended to health care at the site, search and rescue teams, demolition and hauling teams, those who cleaned apartments and residents that moved back into the neighborhoods.

First Responders

All of these individuals took health-related risks, risks that are hard for many of us to understand, but none more so than the first responders. I certainly would not be one to run straight into the face of danger, despite that being in my genes. Growing up in a family of firemen meant that we came to terms early on that loved ones would risk their lives to save others. However, the honor and pride these men have shown throughout our lives often leaves us in fear. My admiration for my Father’s inherent need to help others gave way at times to fears of losing my hero to saving the lives of others buried in ashes. When asked why he chose to become a fireman, my dad, Rodney Fender, humbly said, “It’s just who I am. I want to help people.” He went on to describe the feeling that overcame him as a fireman, the one to rush into danger, saying his logical reaction to the call was, “How the hell do I get in there, and how do I get them out safely.” His immediate response has never been to think about himself above others.

When asked about this innate desire to risk oneself, it became clear that my father, like many rescuers simply react in a way that brings out the best in human nature. A mentality of our heroes following September 11th, who were still there working through the ash and rubble, was best summed up by my grandfather, Michael Fender, also a fireman who said, “It’s just your job as a person to help other people.” He went on to explain that first responders have a mindset like his, “You do what you can, when you can, how you can. That’s just how we work.”

Lifelong Effects

September 11th was a day that changed American lives forever, one that shook our faith in humanity to its core. Like all US Citizens, mental health and safety were altered in significant ways during that time of fear. For the rescue workers though, the risks of danger did not end with the last plane crash or the decision to go to war. For the first responders, volunteers and health care professionals and researchers, September 12th marked another day to face physical and mental health risks to save the lives of others.

The image of an ash covered park in New York City with firemen working tirelessly in the background has been in my kitchen for many years, and serves as a daily reminder to the resiliency of this country, its citizens, and especially its heroes. Although their images are almost invisible in that photograph due to the devastation surrounding them, they are there, digging the city out of the rubble and piecing the lives of others back together.

In a similar vein, Dr. Gillio sat down soon after the attacks to write Lessons Learned at Ground Zero, an essay to, “Help explain to my daughters why mom and dad were away at Ground Zero when planes were falling out of the sky near us in PA. That book found its way to the White House and lead to a request for participation in a series of discussions there regarding the role of the average person or local organization in disaster preparedness, response and recovery. Those lessons in 2001 changed my career from one that treated preventable disease to one that finds ways to discover who is at risk and to intervene to prevent a chronic disease or acute injury and to empower the individual to be the health hero for themselves and their community.”

His message, and that of my father and grandfather, is correct. The terrorist attacks in 2001 changed American life forever. But as health care experts, providers, researchers, policymakers and first responders, it is our duty to take the lessons we learned from those horrific days, weeks and months to build a better system of care. Our job is to use our skills and passions to improve our communities as a whole and prevent, as well as care for, one another as best we can.

For more information, the 2009 World Trade Center Health Registry Report and Findings can be found here: WTCHR.

In five weeks from now, the Patient Protection and Affordable Care Act (ACA) mandates the opening of health insurance exchanges around the country. At that time New Yorkers will be introduced to an innovative way of thinking about health care: Oscar. Three friends, and technology entrepreneurs, teamed up to do something that has been inconceivable to date—create a start-up health insurance company to take on conventional health insurers on the NY exchange. Oscar co-founders, Josh Kushner, Kevin Nazemi and Mario Schlosser, plan to change the health insurance industry through technological interfaces, telemedicine and real transparency. Their goal is to redesign insurance to be geared toward the user experience, to make patients seek out their insurer before their doctor.

Americans do not usually think of health insurance as an intimate part of the care process. When sick, individuals do not call their insurance company for care or support. The health insurance industry is considered confusing, at best. The ACA however, presents an opportunity for the reformation of health insurance as we know it, not because of its disappearance, but by making it an integral part of receiving quality care. According to one co-founder, “We want consumers to feel like they have a doctor in the family.” That family doctor he speaks of is Oscar.

Oscar will have one plan in each of the ACAs metal-tiered categories, and additional plan options for the Bronze and Silver tiers. Although Oscar will have some of the familiar pillars of the health care industry like co-pays and deductibles for in-person visits, it introduces new elements like free telemedicine, free generic drugs and online price comparisons. Oscar health insurance will pioneer “a consumer experience, not a processor of claims,” explained Nazemi, with the goal of simply guiding individuals through the complex health system in an integrative and safe way.

Customer Service: What Oscar Can Do For You

Through user experience, customer service and innovative care options, Oscar will attempt to expand the role of the health insurance company to a health services provider. Oscar is being developed not just to cover medical costs, but to be the primary place to get the medical assistance a patient needs at any time.

When Oscar opens on the New York insurance exchange on October 1st, there will be a focus on function, ease of use and design. When a patient logs into HiOscar.com, he or she will want to keep using it like a new iPhone or laptop, or so the creators hope.

For frequent conditions or issues, patients will be able to find treatments right on the website and have 24/7 access to a physician through their unique partnership with the telemedicine company, TeleDoc. Additionally, the creators claim there will be no need to discuss prescription refills in-person with an expensive physician when a user can have “one-click refills” through a health records feed that resembles a Twitter timeline.

Oscar will also offer services at many hospitals and retail locations such as New York CVS CareMark. The partnership that Oscar and CVS have is so strong that CVS is building sites for Oscar. These added locations will serve as one method of addressing the physician deserts that exist in the state. The company also contends that Value Options is a strategic partner with the goal of making mental and behavioral health care more accessible for the newly insured.

Not everything will be brand new though. Oscar will offer several types of plans like traditional insurance companies, but the approach is slightly different. As Schlosser explains, “packages will be bundled like AT&T, which consumers are now accustomed to.” The intention is to eliminate many of the arcane rules of the insurance industry, which often frustrate patients and erode the customer service experience.

Schlosser tells a story of him, his wife and baby going to CVS in the fall of 2012 to get flu shots in New York City. Schlosser gets his shot, but when his wife goes for hers, she is rejected. The pharmacist explains that Mario’s insurance only covered one shot per 24 hours. Schlosser, who at the time was already working with Kushner and Nazemi on Oscar, explained that Oscar is designed specifically not to have such “Byzantine rules.”

Telemedicine: The Doctor Will See You Now

When describing key functions of their new company, Nazemi and Schlosser emphasize that telemedicine will be the method by which many of their objectives are accomplished. Although telemedicine has been around for a while, it has not been wildly popular with patients to date. Oscar hopes to change that feeling with new incentives, 24-hour online services and a sleek design.

The founders of Oscar claim that consumers will have access to a doctor by phone within 20 minutes of a request, with no co-pay. Perhaps the concept is not revolutionary, but if it works, the behavioral changes associated with seeking care could be seismic. Currently, not many patients log onto insurance carrier webpages before seeing a doctor, unless they are seeing if the doctor is in-network. Oscar, however, wants patients to start their care with the insurer, not just use it for payment submission.

Oscar also plans to have incentive programs such as the “10 for 10,” where patients will receive $10 for answering 10 questions about their health and preferences. The answers from those questions will then be used to establish proactive health care, as well as help the Oscar team make continual upgrades based on user preferences. For example, answers to the “10 for 10” might help create an outreach program for Diabetes patients where a registered nurse would come to the home, or the answers might inform web developers on how utilization could change in the future.

For added flexibility, Oscar asserts it will employ registered nurses and nurse practitioners to provide in-home follow-up services for patients if needed. In the case of new mothers, weekly visits to the home can be arranged if that is preferred over online interaction. Schlosser described his vision of this component as “integrating backwards,” where patients and providers interact in the settings they choose at the times they agree upon.

According to the creators, in addition to the partnership with TeleDoc, Oscar has already amassed some form of relationship with more than 83 hospitals in New York, hoping to make the telehealth to in-person relationship seamless.

Just How Transparent?

Transparency, the newest buzzword associated with the ACA, plays a dual role in the Oscar story. The availability of data drove Oscar’s operation and consumer focus, and has been an integral part of their ability to test their interface with government feedback. Schlosser describes tracking and analyzing years of medical claim data for entire episodes of care to help assess how technology and telemedicine may better treat patients. His go-to example relates to how many people use expensive physician time and technology for simple ailments like headaches, where large percentages of costs go to small percentages of patients.

Data analysis like Schlosser describes are only the beginning. As more medical data becomes available under the ACA, more and more relevant analyses will be conducted. The Oscar team is counting on this improved data to help them meet patient needs on the platform as well as potentially predict future health demands. Like their past Instagram endeavor, the group hopes to make data the backbone of sharing information.

Oscar’s creators were quick to stress that design and functionality are also deeply rooted in transparency. Schlosser explains that the interface will allow consumers to see price differences based on location, facility and desired services.

On Oscar, a user will supposedly be able to look up prices for doctors across the street from one another or shop for MRI pricing by facility. Schlosser boasts that patients will be able to view “heat maps of services and providers.” The question, however, of whether patients will actually log on to compare prices remains unanswered. Human behavior indicates that unless cost savings are passed on to the consumer, there is very little incentive to look for or care about alternatives.

Media Experts As Marketers

Oscar’s founders plan to target all uninsured in their market area. Based on Oscar’s innovative approach to insurance, and the creator’s unique backgrounds in social media, the marketing endeavor will surely be novel. Nazemi says that the approach to courting the uninsured will “include traditional and nontraditional forms of media,” with the ultimate goal being, “to win over every consumer.” This winning of the consumer, or patient, will include all of the feedback mechanisms and personal interaction that allow for real time updates to the company.

Although Oscar will be targeting the entire uninsured population in their New York market, it is likely that the young, healthy and social media savvy will be the easiest to penetrate with marketing materials. This population, however, has been of the greatest concern for the constructors of the ACA, and the reason the individual mandate exists. As time progresses we will see how Oscar uses its flexibility to attract and maintain a young and healthy population that is the least likely to pay for insurance.

Currently, the Oscar site is merely a welcome page and a list of open positions within the company. But, on October 1st, the site will be fully functioning, possibly putting other sites and insurers to shame. It is certain, given its creative employee background, that the feel and design of Oscar will be more user friendly than the state-based or federal sites.

According to Schlosser, the idea for consumer usage is to have a site where, “like Google, you can come use Oscar. You can type in your issue and we will help you find the best solution.” He explained that the entire experience will be interactive.

When asked about their role or faith in the success of the ACA, the team commented that, “the ACA is a catalyst for what we’re doing.” And the creators hope that Oscar will become a catalyst for the rest of the health insurance industry to be more transparent. They claim Oscar will set the stage for new expectations and behaviors by consumers, and that people already know they deserve more from their health care system.

Whatever the success of Oscar in the early stages of the exchange market in New York, one thing is for certain; Oscar has the potential to cause much needed disruption to health insurance and health care.

In the US, many health care woes are blamed on the federal or state government. Whether there is too little oversight and lack of transparency or too much interference and regulation, it seems that policy and politics often end up getting blamed for health care system troubles. But what happens when one lives in a country with no functioning government? As one of the poorest countries in the world, with little to no government structure, Nepal has learned that health-related needs depend on local communities as well as international aid. Despite the vast differences between our countries, we have a lot to learn from one another about the underserved, health and decreasing disparities in access and outcomes.

Even with Nepal’s reliance on foreign assistance and continual poor health rankings, the US could learn a lot about a return to local or “community care.” Those in developing countries like Nepal have no alternatives. With poor infrastructure, unpredictable electricity and heat, and mountainous geographic barriers, the people of Nepal depend on local leaders and village health providers to care for the country’s millions of people. While Americans grapple with government involvement in the health sector, the Nepalese are now well versed in the pros and cons of no government organization.

In contrast, the Nepalese are looking to their allies from the States to help facilitate safe and fair democratic elections by the end of 2013.

In Nepal, the Constituent Assembly functioned in place of Parliament for many years, until its dissolution in May of 2012, often leaving health decisions and progress at a standstill. The developing country, which sits in the Himalayas and is home to eight of the world’s ten tallest mountain ranges, ranks 157 on the World Health Organization’s overall 2013 human development index. Moreover, Nepal has recently emerged from a decade-long armed insurgency creating an environment of insecurity and conflict that has only intensified poverty.

At present, the average Nepali spends only 5% of their annual income on health-related needs. According to the US State Department, “Nepal is one of the poorest countries in the world … The country faces several medium- and long-term development challenges, including strained capacity in government, civil society and the private sector to drive the development agenda, high vulnerability to climate change and a massive youth bulge.” Although surprisingly, despite economic troubles, Nepal has used its international aid partners and community-based health structure to become one of very few countries in the world on target to meet several Millennium Development Goals (MDGs).

The immobility of government has lead to geographical pockets where resources are almost nonexistent and dependency on foreign aid is great. Both the State Department and the US Agency for International Development (USAID) are working diligently in the capitol of Kathmandu to create sustainable health care programs that foster education, improve health outcomes and promote financial independence. However, it is difficult to see vast improvements in health outcomes and health equality without an active role by the people’s own government.

One of the added difficulties for health advancement is the country’s overwhelming number of natural disasters. Nepal is one of the most disaster-prone countries on earth. Annually, people experience floods, landslides, droughts, epidemics and persistent seismic activity. Due to these extreme difficulties, in tandem with direct health efforts USAID has created programs unique to Nepal, like the Program for Enhancement of Emergency Response (PEER) which aims at improving education on how to appropriately carry out activities such as search and rescue efforts in collapsed buildings and reduce health risks during disasters.

In addition to USAID, there are several local and international organizations that concentrate on improving health in Nepal and meeting MDGs. One specific organization that has focused on health and care in rural areas for more than 20 years is Himalayan Healthcare, a non-profit organization that specializes in creating viable programs in regions where health posts go unstaffed and undersupplied by the local government. “Rural Nepal, almost universally, has mostly rudimentary health care services which are inadequate but still go a long way if caring village health providers are available,” says Anil Parajuli, Himalayan Healthcare’s co-founder and Nepal-based Program Coordinator.

Like many community health centers in the US, serving both rural and urban communities, the Himalayan Healthcare model is not based on one’s ability to pay. Their mission is to treat anyone regardless of his or her gender, sex, caste, profession, or ability to pay. The President of the Himalayan Healthcare’s Board, Dr. Robert McKersie, believes that the US and Nepal have a lot to learn from one another. He claims that what makes a community center successful in either country is, “having input from the local stakeholders from day number one. Before this can happen the providers have to be accepted by, and have legitimacy with, the stakeholders.”

Dr. McKersie contends this acceptance does not always come easily. “Many of these communities (both Nepalese and underserved communities in the States) have historically been used or misled by ‘outsiders’. The buy in process for us was health care. After Himalayan Healthcare proved itself, we were ‘invited’ to help with what became the other two tenets of our community development model, namely education and income generation.” He goes on to say that, “organizations in the States that have done good community medicine know this model of having the community members have a stake in their healthcare.”

With so many differences, yet so many similarities in our underserved populations, it is no wonder health care providers in the US and Nepal view one another as a source of knowledge and inspiration.

At present, the next scheduled elections in Nepal have been set for November 2013.